Urinary incontinence in multiple sclerosis: prevalence, severity and impact on patients’ quality of life

Zecca, Chiara; Riccitelli, Gianna Carla; Disanto, Giulio; Singh, Anubha; Digesu, G. Alessandro; Panicari, Letizia; Puccini, Federica; Mattioli, Marco; Tubaro, Andrea; Gobbi, Claudio

doi:10.1111/ene.13010

Cited by 62 publications

(36 citation statements)

References 22 publications

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“…Pereira et al 39 found that UI was not directly associated with quality of life; however, this variable did affect sexual behavior. By contrast, in a study by Zecca et al, 40 approximately 35% of women reported that UI and its negative impact on quality of life was high. An investigation among perimenopausal women 41 found that although the overall prevalence of UI was high (45.3%), few of the affected women sought medical treatment, which in turn had a serious impact on their quality of life.…”

Section: Discussionmentioning

confidence: 75%

A meta‐analysis of pelvic floor muscle training for the treatment of urinary incontinence

Nie

Ouyang

Wang

et al. 2017

Intl J Gynecology & Obste

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Section: Discussionmentioning

confidence: 75%

A meta‐analysis of pelvic floor muscle training for the treatment of urinary incontinence

Nie

Ouyang

Wang

et al. 2017

Intl J Gynecology & Obste

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“…Bladder symptoms, for example, did not contribute significantly to SRH in the multivariate model. This could be due to the relatively low levels of disability in our sample, as bladder dysfunction strongly correlates with overall disability, 23 as well as relatively low ranking in importance that patients assign to bladder dysfunction compared to fatigue, for example. This consideration might also partially explain the low degree of persistence on the various classes of medications for overactive bladder.…”

Section: Discussionmentioning

confidence: 91%

Which symptoms contribute the most to patients’ perception of health in multiple sclerosis?

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et al. 2017

Multiple Sclerosis Journal - Experimental, Translational and Cl

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BackgroundMultiple sclerosis is a polysymptomatic disease. Little is known about relative contributions of the different multiple sclerosis symptoms to self-perception of health.ObjectivesTo investigate the relationship between symptom severity in 11 domains affected by multiple sclerosis and self-rated health.MethodsMultiple sclerosis patients in two multiple sclerosis centers assessed self-rated health with a validated instrument and symptom burden with symptoMScreen, a validated battery of Likert scales for 11 domains commonly affected by multiple sclerosis. Pearson correlations and multivariate linear regressions were used to investigate the relationship between symptoMScreen scores and self-rated health.ResultsAmong 1865 multiple sclerosis outpatients (68% women, 78% with relapsing–remitting multiple sclerosis, mean age 46.38 ± 12.47 years, disease duration 13.43 ± 10.04 years), average self-rated health score was 2.30 (‘moderate to good’). Symptom burden (composite symptoMScreen score) highly correlated with self-rated health (r = 0.68, P < 0.0001) as did each of the symptoMScreen domain subscores. In regression analysis, pain (t = 7.00), ambulation (t = 6.91), and fatigue (t = 5.85) contributed the highest amount of variance in self-rated health (P < 0.001).ConclusionsPain contributed the most to multiple sclerosis outpatients’ perception of health, followed by gait dysfunction and fatigue. These findings suggest that ‘invisible disability’ may be more important to patients’ sense of wellbeing than physical disability, and challenge the notion that physical disability should be the primary outcome measure in multiple sclerosis.

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“…Notably, additional improvements in specific dimensions of patients' QOL (i.e., avoidance and limiting behavior, psychosocial impact, and social embarrassment) were observed. Some studies have concluded that bladder dysfunction is one of the key determinants of poor QOL in patients with MS 20 ; ≈70% consider urinary symptoms to have moderate to high negative effects on QOL. 21 Given that improving QOL is an important treatment goal in patients with MS, 22 results from this study provide further evidence of the clinical benefits of onabotulinumtoxinA and their positive effect on QOL, particularly at the lower dose of onabotulinumtoxinA.…”

Section: Discussionmentioning

confidence: 99%

Low-dose onabotulinumtoxinA improves urinary symptoms in noncatheterizing patients with MS

et al. 2018

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ObjectiveTo evaluate the efficacy and safety of onabotulinumtoxinA 100 U in noncatheterizing patients with multiple sclerosis (MS) with urinary incontinence (UI) due to neurogenic detrusor overactivity (NDO).MethodsIn this randomized, double-blind phase III study, patients received onabotulinumtoxinA 100 U (n = 66) or placebo (n = 78) as intradetrusor injections via cystoscopy. Assessments included changes from baseline in urinary symptoms, urodynamics, and Incontinence–Quality of Life (I-QOL) total score. Adverse events (AEs) were assessed, including initiation of clean intermittent catheterization (CIC) due to urinary retention.ResultsOnabotulinumtoxinA vs placebo significantly reduced UI at week 6 (−3.3 episodes/day vs −1.1 episodes/day, p < 0.001; primary endpoint). Significantly greater proportions of onabotulinumtoxinA-treated patients achieved 100% UI reduction (53.0% vs 10.3%, p < 0.001). Significant improvements in urodynamics (p < 0.01) were observed with onabotulinumtoxinA. Improvements in I-QOL score were significantly greater with onabotulinumtoxinA (40.4 vs 9.9, p < 0.001) and ≈3 times the minimally important difference (+11 points). The most common AE was urinary tract infection (25.8%). CIC rates were 15.2% for onabotulinumtoxinA and 2.6% for placebo.ConclusionIn noncatheterizing patients with MS, onabotulinumtoxinA 100 U significantly improved UI and quality of life with lower CIC rates than previously reported with onabotulinumtoxinA 200 U.ClinicalTrials.gov identifier:NCT01600716.Classification of evidenceThis study provides Class I evidence that compared with placebo, 100 U onabotulinumtoxinA intradetrusor injections significantly reduce UI and improve quality of life in noncatheterizing patients with MS and NDO.

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Urinary incontinence in multiple sclerosis: prevalence, severity and impact on patients’ quality of life

Cited by 62 publications

References 22 publications

A meta‐analysis of pelvic floor muscle training for the treatment of urinary incontinence

A meta‐analysis of pelvic floor muscle training for the treatment of urinary incontinence

Which symptoms contribute the most to patients’ perception of health in multiple sclerosis?

Low-dose onabotulinumtoxinA improves urinary symptoms in noncatheterizing patients with MS

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